Exhibit 1 (model language for DDS letter to DHS)
DDS Letterhead
Department of Homeland Security District Office
(Address)
We are writing to obtain medical evidence on behalf of (claimant's name and
address) who has applied for payments based on disability or blindness under the Supplemental
Security Income provision of title XVI of the Social Security Act. This agency is
responsible for determining, on behalf of the Commissioner of the Social Security
Administration, whether the claimant is disabled or blind and whether the onset of
disability or blindness occurred before or after admission to the United States for
permanent residence.
To make such a determination, we need a copy of Form OF-157 (Medical Examination of
Visa Applicants) and/or any other medical reports contained in your file. The claimant's
authorization is enclosed.
The claimant was admitted to the United States for permanent residence on _______
(date), at ________ (place of entry) and was going to live at _________ (address). His or her non-citizen registration number is .
Your prompt response will help assure a speedy decision on this claim. If you have
any questions, please call this agency collect. Thank you for your cooperation.
Sincerely yours,
Chief Medical Consultant
Enclosure
Exhibit 2 – Disability Determination Notice – Non Citizens Age 65 and Older
[
(Claimant Name)(SSN)
INFORMATION ABOUT THE DISABILITY DECISION
The Decision on Your Case
(For personalized disability explanation instructions, see DI 26530.000)
About the Decision
Doctors and other trained staff looked at your case and made this decision. They work
for the State but used our rules.
Please remember that there are many disability programs, both government and private,
that use different rules. A person may be receiving benefits under another program
and still not be entitled under our rules. This may be true in your case.
The Disability Rules
You must meet certain rules to qualify for SSI payments based on disability. Your
health problems must:
keep you from doing any kind of substantial work (described below), and
last, or be expected to last, for at least 12 months in a row, or
be expected to result in death
You must meet certain rules to qualify for SSI payments based on blindness.
Your eyesight must be no better than 20/200 in the better eye with the use of a corrective
lens, or
Your visual fields must be restricted to 20 degrees or less.
You can qualify for SSI benefits due to blindness even if you can do substantial work.
Information About Substantial Work
Generally, substantial work is physical or mental work you are paid to do. Work can
be substantial even if it is part-time. To decide if your work is substantial, we
consider the nature of the job duties, the skills and experience you need to perform
the job, and your earnings.
Usually, we find that your work is substantial, if your gross earnings average over
$1000 per month after we deduct allowable amounts. Your work may be different from
your work before your health problems began. It may not be as hard to do and your
pay may be less. However, we may still find that your work is substantial under our
rules.
If you are self-employed, we consider the kind and value of your work, including your
part in the management of the business, as well as your income, to decide if your
work is substantial.
Exhibit 3 (map of DHS regional and district areas)
Exhibit 4 (DHS regional offices)
DHS Region
|
Office Address
|
Eastern Region (BUR)
|
Burlington, Vermont 05401 Federal Building Elmwood Avenue
|
Northern Region (STP)
|
Twin Cities, Minnesota 55111 Bishop Henry Whipple Federal Building Fort Snelling
|
Southern Region (DLS)
|
Dallas, Texas 75270 Skyline Center Building C 311 North Stemmons Freeway
|
Western Region (SPD)
|
San Pedro, California 90731 Terminal Island
|
Exhibit 5 (DHS servicing offices by state)
State
|
DHS DO Number
|
DHS Regional Office
|
Alabama
|
26
|
Southern
|
Alaska
|
32
|
Northern
|
Arizona
|
18
|
Western
|
Arkansas
|
28
|
Southern
|
California
|
13, 16, 39
|
Western
|
Colorado
|
19
|
Northern
|
Connecticut
|
23
|
Eastern
|
Delaware
|
4
|
Eastern
|
D.C.
|
25
|
Eastern
|
Florida
|
6
|
Southern
|
Georgia
|
26
|
Southern
|
Hawaii
|
17
|
Western
|
Idaho
|
30
|
Northern
|
Illinois
|
9
|
Northern
|
Indiana
|
9
|
Northern
|
Iowa
|
29
|
Northern
|
Kansas
|
11
|
Northern
|
Kentucky
|
28
|
Southern
|
Louisiana
|
28
|
Southern
|
Maine
|
22
|
Eastern
|
Maryland
|
5
|
Eastern
|
Massachusetts
|
2
|
Eastern
|
Michigan
|
8
|
Northern
|
Minnesota
|
10
|
Northern
|
Mississippi
|
28
|
Southern
|
Missouri
|
11
|
Northern
|
Montana
|
30
|
Northern
|
Nebraska
|
29
|
Northern
|
Nevada
|
13
|
Western
|
New Hampshire
|
2
|
Eastern
|
New Jersey
|
21
|
Eastern
|
New Mexico
|
15
|
Southern
|
New York
|
3,7
|
Eastern
|
North Carolina
|
26
|
Southern
|
North Dakota
|
10
|
Northern
|
Ohio
|
24
|
Northern
|
Oklahoma
|
20
|
Southern
|
Oregon
|
31
|
Northern
|
Pennsylvania
|
4
|
Eastern
|
Puerto Rico
|
27
|
Eastern
|
Rhode Island
|
2
|
Eastern
|
South Carolina
|
26
|
Southern
|
South Dakota
|
10
|
Northern
|
Tennessee
|
28
|
Southern
|
Texas
|
14, 15, 20, 38
|
Southern
|
Utah
|
19
|
Northern
|
Vermont
|
1
|
Eastern
|
Virginia
|
25
|
Eastern
|
Washington
|
12
|
Northern
|
West Virginia
|
4
|
Eastern
|
Wisconsin
|
9
|
Northern
|
Wyoming
|
19
|
Northern
|
Wisconsin
|
9
|
Northern
|
Wyoming
|
19
|
Northern
|
Exhibit 6 (DHS district offices)
DHS District Offices
DO Abbrev.
|
Office
|
2 (BOS)
|
Boston, Massachusetts 02203
John Fitzgerald Kennedy
Federal
Building
Government Center
|
3 (NYC)
|
New York, New York 10278
26 Federal Plaza
|
4 (PHI)
|
Philadelphia, Pennsylvania
19106
Room 1321 U.S. Courthouse
Independence Mall West
601 Market Street
|
5 (BAL)
|
Baltimore, Maryland 21201
E.A. Garmatz Federal Bldg.
101 West Lombard
Street
|
6 (MIA)
|
Miami, Florida 33138
7880 Biscayne Blvd.
|
7 (BUF)
|
Buffalo, New York 14202
68 Court Street
|
8 (DET)
|
Detroit, Michigan 48207
Federal Bldg.
333 Elliot St.
|
9 (CHI)
|
Chicago, Illinois 60604
Dirksen Federal Office Bldg.
219 South
Dearborn St.
|
10 (SPM)
|
St. Paul, Minnesota 55101
927 New Post Office Bldg.
180 N. Kellogg
Blvd.
|
11 (KAN)
|
Kansas City, Missouri 64106
Suite 1100, 324 E. Eleventh St.
|
12 (SEA)
|
Seattle, Washington 98134
815 Airport Way, South
|
13 (SFR)
|
San Francisco, California 94111
Appraisers Bldg.
630 Sansome Street
|
14 (SNA)
|
San Antonio, Texas 78206
Suite A301
U.S. Federal Bldg.
727
East Durango
|
15 (ELP)
|
El Paso, Texas 79984
343 U.S. Courthouse
P.O. Box 9398
|
16 (LOS)
|
Los Angeles, California 90012
300 North Los Angeles Street
|
31
(POO)
|
Portland, Oregon
Federal Office Building
511 N.W. Broadway
|
32 (ANC)
|
Anchorage, Alaska 99513
New Federal Building
701 C St. RM.
D-251
Lock Box 16
|
17 (HHW)
|
Honolulu, Hawaii 96809
P.O. Box 451
595 Ala Moana Blvd.
|
18 (PHO)
|
Phoenix Arizona 85025
Federal Bldg.
230 North First Avenue
|
19 (DEN)
|
Denver, Colorado 80202
1787 Federal Bldg.
1961 Stout St.
|
20 (DAL)
|
Dallas, Texas 75242
Room 6A21, Federal Bldg.
1100 Commerce St.
|
21 (NEW)
|
Newark, New Jersey 07102
Federal Bldg.
970 Board Street
|
22 (POM)
|
Portland, Maine 04112
76 Pearl St.
|
23 (HAR)
|
Hartford, Connecticut 6103-3060
Ribicoff Federal Bldg.
450 Main St.
|
24 (CLE)
|
Cleveland, Ohio 44199
Rm. 1917
Anthony J. Celebreeze
Federal
Office Bldg.
1240 East 9th St.
|
25 (WAS)
|
Washington, D.C. 20013
25 E Street, N.W.
P.O. Box 37034
|
26 (ATL)
|
Atlanta, Georgia 30303
Rm. 1408
Richard B. Russell
Federal
Office Bldg.
75 Spring St., S.W.
|
27 (SAJ)
|
San Juan, Puerto Rico 00936
GPO Box 5068
|
28 (NOL)
|
New Orleans, Louisiana 70113
Postal Service Bldg.
R.M.
T-8005
701 Loyola Avenue
|
29 (OMA)
|
Omaha, Nebraska 68102
Federal Office Bldg.
Room 1008
106
South 15th St.
|
30 (HEL)
|
Helena, Montana 59626
Federal Building, Room 512,
Drawer
10036
310 South Park
|
38 (HOU)
|
Houston, Texas 77004
2627 Caroline St.
|
39 (SND)
|
San Diego, California 92188
880 Front Street
|
40 (HLG)
|
Harlingen, Texas 78550
2102 Teege Road
|